Project Summary/Abstract Norris Cotton Cancer Center (NCCC), the keystone of the cancer-related activities of both Dartmouth College, including its Geisel School of Medicine, and Dartmouth-Hitchcock Health, will participate in the NCI's National Clinical Trials Network as a Lead Academic Participating Site. NCCC has a long history of leadership in national cooperative group clinical trials, dating back to serving as an operating center for CALGB, and more recently as a main member of the Alliance for Clinical Trial in Oncology, NRG, COG, and ECOG/ACRIN. As the only NCI- designated Comprehensive Cancer Center in northern New England, NCCC currently serves annually over 5,000 new patients and 30,000 returning cancer patients. NCCC is the specialty academic center for Vermont and New Hampshire, anchoring a network of 17 community-based practice sites across the region and receiving referrals of rare and advanced cancers, the target population for enrollment on innovative clinical trials, from a large geographic catchment area. Within Dartmouth, NCCC has a central Office of Clinical Research (OCR) which coordinates full participation in the entire range of available clinical trials. NCCC intends to participate fully in all NCTN activities, expanding its prior focus on participation in the Alliance. NCCC investigators are active in many NCTN Operations Center committees, facilitating a bi-directional integration of NCCC concepts into the NCTN, while NCTN studies will be seamless incorporated into the NCCC trial portfolio. We anticipate accrual of 55 consented subjects on high performance intervention for treatment trials and 20 subjects on screening only accruals for treatment or imaging trials. Care at DH is organized into 17 designated interdisciplinary disease-based teams which bring together all relevant specialties, 14 on a weekly basis, for new patient conferences at which eligibility for enrollment on clinical trials is assessed routinely. NCCC research nurses assigned to these Clinical Oncology Groups (COGs) are responsible for keeping the teams informed of available trials, and the NCCC clinical trials management system (Velos eResearch) provides the teams reports tracking current enrollment. While highest priority is given to translating NCCC science into clinical application, Dartmouth's size precludes most single-institution studies, and national cooperative group trials are prioritized ahead of industry-initiated studies for fulfillment of NCCC's clinical research mission.